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Home My Public Portal About10643 OLIVE ST_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 , sur.,or q cerdMficate of Workers'Compensation Insurance,or a 76A667A certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company E] Certified copy is hereby furnished. BUILDING F1FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS 06 q department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY �p Date Applicant 1 WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' f 'BATH TUB CROSS ST. t" COMPENSATION INSURANCE SHOWER OWNER Q� (This section need not be completed if the work involved by I MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY 1 d ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL.NO mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date. Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- ow E2:11 SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY `0 TEL. NO sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS aa ly with such provisions or this permit shall be deemed revok- STATE LIC.' ed. WATER HEATER LICENSE.NO. CLASS LICENSED CONTRACTORS.DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE a License Number Lic. Class FINAL . . C AC-_IT Contractor Date BY c O I am exempt under Sec. �-+ -� f' 3303 i a.50 W B.BP.C. for this reason ► Plan check fee STEMS FA Date: PLUMBING PERMIT ISSUING FEE$ Z 7 3a TOTAL 78:5.501? Signature �_, TOTAL FEE SINGLE FAMILY d CHEECK 775.50 HOME OWNER-BUILDER DECLARATION Plan check applicant CHANGE .00 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and S+,, Professions Code): AddressgrA ozloe_ , CIO0 -- 1 }/ Oi =y I, as owner of the property, will do the work and the -City 04Tel. No. •1224 1 AM 8:06 structure is not intended or offered for sale(Section 7044, r Business and Professions Code). pop- CONSTRUCTION CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the , above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize D ives f this County to enter upon the abov ent' per for inspection purposes. �,��f�� SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date r WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT +'1 hereby'affirm that I have a certificate of consent to self 20-0026 DPW 6/87 ir1sure, or a certificate of Workers'Compensation Insurance, 76AG67A or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished.❑ BUILDING ,1 FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date. Appligant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS JUS I certify that in the. performance of the work for which this off permit Is issued, I shall not employ any person in any manner SINK CITY o TEL.•NO.o so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant- CLOTHES CLOTHES WASHER ADDRESS; NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions.of the Labor Code, you must forth- LAWN SPRINKLER.SYSTEM with comply with such provisions or this permit shall be i STATE LIC. deemed revoked., I WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY' I hereby affirm-that I am.licensed under provisions of Chapter 9 GAS SYSTEM .OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE License Number Lic. Class Ca FINAL Contractor Date BY a ❑ 1 am exempt under Sec: ii Cl B.&P.C. for thi3 reason ® ACC i a Cr - Cr check fee PLUMBING PERMIT ISSUING FEE$ /lp50 3307 Signature ' r- TOTAL FEE (i Gil Plan check applicant TOTAL 26 . 211 SINGLE FAMILY T� P r-,(! HOME-OWNER:BUILDER.DECLARATION Name v �CK. I hereby affirm:that I am exempt from the Contractor's License 4 Law for the following reason (Section 7031.5, Business and Address CHANGE 0)111 Professions Code): City Tel. No. ' I', as owner of the property, will do the work and the' l[i l-ar l i A structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® +3];ii°!1#i�it; CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of thisunty'to enter upon the above-men' e r party f r i 'is . purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig Lure.of Permittee Date ' 76A687A(�CE'y917B) • 77.':'' �- : �� ..APPLICATION FOR PLUMBING PERMIT r BUILDING AND SAFETY DIVISION � FOR APPLICANT FILL IN(PRINT OR TYPE( AD (p BUILDING DRESS d 43 O L% NUMBER FIXTURE ORR ITEM ® FEE - WATER CLOSET '? LOCALITY Z. s NEAREST ,BATH TUB �} CROSS ST. SHOWER OWNER LAVATORYMAIL U-0 ADDRESS ' S f-ill�^ SINK CITY TEL.NO.44A-0qcj DISHWASHER 9 CONTRACTOR CLOTHES WASHER - �v ADDRESS �j {� (p `yoY� a SWIMMING POOL RECEPTOR CITY �,()`J�Lo`/ (-A TEL.NO. LAWN SPRINKLER SYSTEMSTATE Q WATER HEATER ,�,1 LICENSE NO. a� � U LIC. �r7 GAS SYSTEM OUTLETS 2 V DISTRICT NO. GROUP ZONE P ESSED BY } OPER TS OVER d S 0 8 ''" ""� C INDUSTRIAL WASTE APPROVAL C INSPECTION RECORD- 4 a v z Plan check fee PLUMBING PERMIT ISSUING FEE$ i TOTAL FEE S v Plan check applicant Name APPROVALS DATE INSPECTOR'S IGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1'AM THE GAS TEST Z LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. r UTILITY CO.NOTIFIED SIGNATURE • OF PERMITTEE FINAL O PLAN CHECK VALIDATION CIC. M.O.�J CASH PERMIT VALIDATION CK. y� M.D. CASH C bL C G ISA- ./til dJG�I.0 f" 7 0 Q'hJUN i 2 5- .V 0 Aw 76A667-CE#817 2-62 zg�F y l APPLICATION :F'OR- PLUMBING PERMIT �. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTYENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN "NEAREST CROSS ST._ NUMBER FIXTURE OR ITEM EACH FEE OWNER lalov,AL WATER CLOSET $1.25 ....MAILA.11 i BATH TUB 1.25 . ADDRESS SHOWER 1.25 CITY TEL. T LAVATORY 1,2 CONTRACTOR DONIS PL ppmmimG SERVICE SINS 1.25 ADDRESS 840 SA. LIIdwin AY&.'YI4Je DISHWASHER 1.25 CITY -Arcadia, CGlif. TELAOO"Mg LAUNDRY TUB 1.25 CONTRACTOR'S. STATE REGISTRATION NO. COUNTY CLOTHES WASHER 1.95 DISTRICT NO. GROU ZONE PR ESSED BY WATER HEATER 1.50 i t GAS SYSTEM. OUTLETS 1.50 INDUSTRIAL ' WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD I " ✓ r JF 0 V W RA c - N z APP FAL- _ DATE INSPECTOR'S SIGNATURE PERMIT $ .2 00 UNDER `t�'A&WORK 1.4 J. A.. ROUGH PLUMBING, �'�h��' ¢p •`' �V� f TOTAL FEE flGAS PIPING r I HEREBY ACKNOWLEDGE THAT 1 HAVE-READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND 'AGREE TO 'COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER y / -7 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED-.AND/OR PLUMBING FIXTURES LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST •• '✓ < P �,�' RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE 'r FINAL �p. jASt. fi? ALIDATION ROBERT A.WOOD r s CK. M.O. CASH SUPERVISING MECHANICAL ENG'R' LACo 07-9 1 FEB 11 5 D 10.00- 76A887-CE#817 10-62 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER DDRESS 61 WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FML IN NEAREST S . d )C C ,r 'D�r NUMBER FIXTURE OR ITEM EACH FEE OWNER L]•gyp L� — LYJ WATER CLOSET $1.25 �j�y MAIL BATH TUB 1.25 DDRESS 8 3 a -9 /; C+ 1)� SHOWER 1.25 CITY LAVATORY 1.25 CONTRACTOR SINS 1.25' ADDRESS DISHWASHER 1.25 CITY TEL. NO. - LAUNDRY TUB 1.25 CONTRACTOR'S STATE [03REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTR CT N G�UP� Z NEP SEED BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 WASTEAPAPPROVAL OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD h e/ �® R� pit tl N APPROVALS DATE,, INSPECTOR'S SI.GNAT1U RE PERMIT S 2 00 UNDER SLAB WORK !� ROUGH PLUMBING TOTAL FEE 3 GAS PIPING r I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/I PLUMBING FIXTURES j f LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST ' I CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE f#VE DESCRIBED.RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATUREs A —.' 1, OF PERMI E J� FINAL 1,/;;? Q /�"r ! '" LIDATION ROBERT A(WOOD CK. m.0., CASH SUPERVISING MECHANICAL ENG'R Li'IGO 5,6 2 v;o J"'I L. 5 D 3.50- w